ORBi: Demertzi Athina - Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue

Reference : Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics i...


	Document type :	Scientific journals : Article
	Discipline(s) :	Human health sciences : Neurology
	To cite this reference:	http://hdl.handle.net/2268/111561

Title :	Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue
Language :	English
Author, co-author :	Demertzi, Athina [Université de Liège - ULg > > Centre de recherches du cyclotron >]
	Racine, Eric [> >]
	Bruno, Marie-Aurélie [Université de Liège - ULg > > Centre de recherches du cyclotron >]
	Ledoux, Didier [> >]
	Gosseries, Olivia [Université de Liège - ULg > > Centre de recherches du cyclotron >]
	Vanhaudenhuyse, Audrey [Université de Liège - ULg > > Centre de recherches du cyclotron >]
	Thonnard, Marie [Université de Liège - ULg > > Centre de recherches du cyclotron >]
	Soddu, Andrea [Université de Liège - ULg > > Centre de recherches du cyclotron >]
	MOONEN, Gustave [Centre Hospitalier Universitaire de Liège - CHU > > Neurologie Sart Tilman >]
	Laureys, Steven [Université de Liège - ULg > > Centre de recherches du cyclotron >]
Publication date :	4-Jan-2012
Journal title :	Neuroethics
Publisher :	Springer Netherlands
Pages :	1-14
ISSN :	1874-5490
Keywords :	[en] Pain ; End-of-life ; Vegetative state ; Minimally conscious state ; Ethics ; Attitudes ; Survey
Abstract :	[en] Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments.
Permalink :	http://hdl.handle.net/2268/111561
DOI :	10.1007/s12152-011-9149-x
Other URL :	http://reflexions.ulg.ac.be/ethiquevieetmort

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